Effective care refers to services that are of proven value and have no significant tradeoffs -- that is, the benefits of the services so far outweigh the risks that all patients with specific medical conditions should receive them. These treatments, such as providing beta-blockers for heart attack patients, are backed by strong scientific evidence of efficacy.

Despite all the resources expended on health care in the United States, sometimes treatments that are known to be effective are not used. As the Dartmouth Atlas Project has documented, the underuse of effective care is widespread and occurs even at some hospitals considered among the best in the country. A 2003 study by the Rand Corporation published in the New England Journal of Medicine found that Americans receive only about 55% percent of recommended care for a variety of common conditions.

The failure to provide effective care can have dire consequences for patients. It is well established that beta-blockers can reduce the risk of heart attack in patients who have already had one heart attack. Yet many heart attack patients are never prescribed beta-blockers. For patients with diabetes, annual eye exams can help avoid the possibility of blindness; yet many diabetic patients do not receive annual eye exams.

Given that providers agree on the importance of providing these types of treatments, why do so many patients go without them? The answer is not a lack of money. The Dartmouth Atlas Project has found that there is no correlation between higher spending and more widespread use of effective care. The causes of underuse include fragmented care (which tends to grow worse when more physicians are involved in the patient’s care) and the lack of systems to ensure that all eligible patients receive these treatments.

The remedies for underuse of effective treatments lie in fostering the development of organized and integrated physician practices that can implement reliable processes and changes to the payment system to reward better care, not simply more care.

The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health
Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation,
including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.